Provider Demographics
NPI:1619367901
Name:WAHLBERG COUNSELING SERVICES
Entity Type:Organization
Organization Name:WAHLBERG COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NIKKI
Authorized Official - Middle Name:R
Authorized Official - Last Name:WAHLBERG
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:719-271-6306
Mailing Address - Street 1:4795 SIGNAL ROCK RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80922-1625
Mailing Address - Country:US
Mailing Address - Phone:719-271-6306
Mailing Address - Fax:719-362-4390
Practice Address - Street 1:1465 KELLY JOHNSON BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3955
Practice Address - Country:US
Practice Address - Phone:719-271-6306
Practice Address - Fax:719-362-4390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO000020141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty